4&20 blackbirds

Why Democrats Losing the Senate Isn’t the End of the World

Robert Gibbs didn’t mince his words last month regarding the distinct possibility of Democrats losing the Senate. If that happens then, according to Gibbs, “turn out the lights, because the party is over.”

For some reason Gibbs thinks Obama needs to do more to raise money in order to make the midterms more competitive. But what Gibbs doesn’t seem to be including in his calculation is the toxic presence of Obama for many Democrats, especially in states like Montana, where both the president and his signature legislation, the Affordable Care Act, remains very unpopular.

But wait, isn’t the ACA celebrating 7 million “consumers” coerced into the private insurance market? Yes, and I’m sure there are some Democrats letting out a few sighs of relief. But there are also folks who still understand what a giant scam the ACA debacle is, and the popular resistance against Obama’s signature legislation is far from being pacified (h/t problembear). From the link:

As Kevin Zeese and I wrote last fall, the ACA is one of the biggest insurance scams in history. It has made the already complex American health system, which spends over a third of health care dollars on insurance-created bureaucracy rather than care, much more complicated. It is based on principles that are the opposite of what are proven to be effective. Instead of being universal, everybody automatically enrolled as we did for seniors when Medicare started in 1965 and as most other industrialized nations do, we created a conservative, means-tested system that depends on individual income.

And instead of creating a single standard of care, so that everyone has access to the health care they need, the ACA locked into law a tiered system of coverage based on different metals: platinum, gold, silver and bronze. Though they may sound good, it turns out that the upper tier plans are not any better than the lower tier plans in terms of what services are covered or where patients can go for care. The major difference is whether a person chooses to pay more up front in higher premiums and pay less when they need health care (upper tier plans) or chooses to gamble on staying healthy and pay less up front, risking higher out-of-pocket costs if they need care (lower tier plans). This is essentially a pay-now-or-pay-later scheme.

And it is a scheme, because there are no guarantees that people who have insurance will be protected from financial ruin if they have a serious health problem. It is essential to remember that nothing about the basic business model of insurance companies has changed. They exist to make a profit and they are very good at it. While they complain about the ACA, because its regulations require more work on their end to find ways around them, it has been very lucrative for them. Health insurance stock values have doubled since the law passed in 2010.

One of their major work-arounds is the use of narrow and ultra-narrow provider networks to discourage patients with pre-existing conditions from buying their plans and leave patients footing more of the bill. Narrow networks exclude at least 30% of local hospitals and ultra-narrow networks exclude at least 70%. This means that if the local cancer center isn’t included in a plan, then people with cancer are unlikely to buy that plan. To make it worse, it’s difficult for patients to determine what providers are included in different plans because the information on the insurance exchange websites has been found to be wrong half the time.

The reason for the narrow networks is that when patients don’t go to an approved health provider, they bear most or all of the costs. The limit on how much money people can be required to spend in addition to premiums doesn’t apply when patients go out of network (and the limit was removed for 2014 anyway). In practice, if someone develops a serious health condition and the hospital or health professional that treats the condition is not in their network, they will have to go without care or find a way to pay for it. And if a person has a serious accident and is taken to a hospital that is out of network, the patient will again bear the total cost. Buying insurance is a health care crap shoot.

Not everything is doom and gloom for Democrats. Losing the Senate could actually be a silver lining in Hillary Clinton’s 2016 playbook. To explain the counterintuitive hypotheticals, Dave Weigel at Slate has compiled the potential positives:

– The new GOP Congress would be unable to keep a lid on itself. On day one you’d see a Benghazi select committee (which, the theory goes, would diffuse the scandal with overcoverage) and a fight to repeal the ACA. Republicans like John Cornyn and Jim Jordan, people in positions of power, have said that a Republican Congress would hand Obama a budget that defunded Obamacare, on the theory that winning an election and passing the thing in both houses would fatally weaken his hand.

– Clinton would get to run against Congress. “It would be much harder to diffuse blame for a ‘Do-Nothing Congress,’ ” argues Norm Ornstein. Republican presidential candidates would have to triangulate between Clinton and their own Congress, as George W. Bush did in 2000. (That was sort of the point of “compassionate conservatism.”)

– Democratic voters, who are horribly lazy about midterm voting, would be newly energized to take back what was lost. Democratic fundraising for Clinton and the 2016 Democratic Senate team would surge—useful, because Democrats want to win seats lost in the 2010 wave, in states like Wisconsin, Pennsylvania, and Illinois.

Because I’ve gotten way too cynical for party politics, I asked for some feedback in my last post about what, specifically, would be bad about Democrats losing the Senate. Turner had this to say:

I worry that if the R’s take the Senate, they’ll block appointments. Especially if a SC Justice dies.

Weigel also addresses this point in the context of a Hillary 2016 run:

– Let’s assume it doesn’t matter if a new Supreme Court nomination happens and the Senate contains 51 Democrats or 51 Republicans. Last year’s filibuster reforms did not lower the vote threshold for SCOTUS nominees, but there’s no precedent for filibustering Supreme Court nominees anyway. That’s not a problem for Democrats. The problem would be a blockade on less-famous nominees for all manner of DOJ, EPA, and Treasury, etc., nominees. It doesn’t advantage Hillary Clinton’s vote-getting in swing states if, come 2016, the Democrats are unable to staff up the Civil Rights Division of DOJ. If the administration can’t get its nominees in place, it’s going to exercise more executive power. Voters don’t always like that—and that’s before a Republican Congress and presidential field calls it tyranny and demands to know whether Hillary Clinton would behave this way.

The problem with all this is the short-sighted focus on the next election cycle. This skewed perspective is what ensures long-term sustainability of our broken economic/political systems will never be substantively addressed.

Swede, I’ve never said this assault on democracy was a one-party phenomenon — it’s a system-wide cancer.

(It’s an interesting list that doesn’t include such heavy hitters as the Koch brothers, Sheldon Adelson or Bloomberg. One tidbit that surprised me: the National Beer Wholesalers Assoc. gave to the Rs. Ds like beer, too.)

As to Margaret Flowers’ strategy of being “a Conscientious Objector to the ACA” I couldn’t disagree more. Whaaaa… folks are saying, JC disagrees with Flowers and being a CO?

While I agree wholeheartedly with Flowers’ critique of the ACA and the american health care “system”, calling for CO’s is the wrong way to go.

Flowers is a wealthy, healthy doctor. She can afford to gamble with the possibility of needing acute or traumatic care for an expensive medical condition. But those of us who cannot, shouldn’t gamble with our lives, hoping that enough people will conscientiously object to turn things around.

Nobody cares that wealthy people like Margaret Flowers, or umpteen millions of people object and will not participate in the ACA. But Baucus made sure that the IRS will keep track and penalize them.

And people like FLowers can afford the penalty, as it is regressive in that while it slides with income, it is capped at an insignificant percent of the wealthy’s income ($2095/family/year). The wealthy already afford to self-insure, so it is simple for a doctor like Flowers to be a CO.

But for those who are low-middle income, the penalty in 2016 will be 2.5% MGI or $695/person (max of $2095, indexed at rate of inflation going forward), and will take a huge hit on them.

Unfortunately, we are in for a few more decades of pain and suffering with how we deal with healthcare in this country, and until a simple, effective system of single payer evolves and becomes politically doable, its only going to get worse.

So for people like me, the simple fact that I have finally been given a green light to enter a system that repeatedly rejected me is huge. Who am I to complain that for about $80 a month, I can finally have health insurance (as bad as it is) and see a doctor without having to freak out about bankruptcy too?

Sure, it’s bad insurance with narrow networks. But the narrowest network is to not have insurance, and to have to wait on the steps of the public health clinic at 7am in the morning hoping they can find a slot for you, so a random doctor or nurse can spend 5 minutes with you before closing time.

Your obsession with access to specialists is revealing. People without insurance, or with bad insurance don’t get to see specialists in any event. Except for when a specialist gives out a few hours to poor people via a lottery or donation to public health clinic. Everybody else just has to let the cancer grow, the arteries clog, or the brain develop an aneurysm until it becomes life or death and the E.R. is compelled by federal law to “stabilize” the condition (which is not the same as giving comprehensive health care). Then the hospital’s debt collectors will hound the patient to bankruptcy or death.

“Job lock?” You mean the kind we had with health insurance being tied to the workplace? People being tied to a job for fear of losing their coverage, or having to accept lesser, more expensive coverage when relocating?

And intentional? You mean the shadow “death panel” of poverty? Sorry, I know that’s five questions in a row. One video will suffice for an answer.

As to going to the polls for “more hopeless change”, that is the wrong place to find change. Look within, grasshopper.

Maybe the health co-ops can be a starting point for a decent system of health care. I was able to get my wife out of an expensive, sketchy, policy out of Texas (she had a minor, pre-existing condition) and onto a Montana Health Co-op plan. I joined the co-op, too. We’re saving about $300/mo. ($600 v. $900). I used to have Blue Cross/Blue Shield.

Granted, it’s a ‘Bronze’ plan with a high deductible and not as many providers but it’s better than what we had. If the co-op numbers continue to grow — it has about 40% of the recent enrollees in Montana — and it links up with other co-ops, could this evolve into a public option … and eventually a single-payer system?

Perhaps this is wishful thinking but I’m a glass-half-full kind of guy. ;)

Well, they tried to kill co-ops by taking the funding away for startups a few years ago. Fortunately, the MHC had their funds approved early on.

While I mostly agree with you, my experience with the co-op has had its challenges (I’ve got a silver plan). It’s plan management was outsourced to Coventry in Florida, and I’ve had some bad experiences with them already (like I’ve been trying since early november to get my address corrected — 5 months later, my address still shows up as “null, null” and I can get no mail from them outside of stuff mailed and hand addressed out of helena).

So right now it seems that the co-op model is mostly a silk lining to the same old health care system. In order for it to be meaningful, it is going to have to operate differently than other insurers (understanding that it still has to operate in the same regulatory framework, of course). I’m willing to give them some time to differentiate themselves, as obviously it takes time for startups to get established and the kinks worked out.

I’ve got a ton of ideas about how outfits like the MHC could help to move our healthcare mess in a better direction, but unfortunately, the politics (dems and reps alike) are not conducive to anything but gridlock right now.

And the MHC did expand into Idaho around the first of the year, so they are figuring out how to grow and work cross-border.